Correlates of Intent to Seek Unnecessary Pap Tests Among Elderly Women

Zhang, Yan; Borders, Tyrone F.; Rohrer, James E.

doi:10.1016/j.whi.2007.06.002

« Previous Next »Women's Health Issues
Volume 17, Issue 6 , Pages 351-359, November 2007

Correlates of Intent to Seek Unnecessary Pap Tests Among Elderly Women

Yan Zhang, PhD
- Department of Family and Community Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
- Yan Zhang, PhD, is an Assistant Professor in the Division of Health Services Research of Family and Community Medicine at Texas Tech University Health Sciences Center. She focuses on health behavioral research targeting the vulnerable populations of children/teenagers, the elderly, women, and minority populations. Her current work is related to aging and Alzheimer’s disease.
- Correspondence to: Yan Zhang PhD, Assistant Professor, Division of Health Services Research, Department of Family and Community Medicine, Texas Tech University Health Science Center, 3601 4th St, STOP 8161-Room 1C165D, Lubbock, TX 79430. Phone: 806-743-6984; fax: 806-743-1292.
Tyrone F. Borders, PhD
- Department of Health Policy and Management and Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Tyrone F. Borders, PhD, is an Associate Professor in the Department of Health Policy and Management and Department of Epidemiology at the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences. He conducts epidemiological research to identify risk factors for poor health care access and health status with an emphasis on rural populations. His current work focuses on the health system and intrapersonal determinants of drug and alcohol abuse.
James E. Rohrer, PhD
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota
- James E. Rohrer, PhD, is Professor of Family Medicine in the Mayo Clinic. He is a managerial epidemiologist who evaluates practice innovations in primary care. His recent work concentrates on the causes, consequences and management of over-eating among free-living primary care patients.

Received 15 August 2006; accepted 1 June 2007. published online 16 October 2007.

Purpose

Cervical cancer screening may be over-used by elderly women who might not benefit from the test. The purpose of this study was to examine the relative importance of objective factors (e.g. intact cervix) and subjective factors (e.g. patients’ Pap-smear related beliefs/attitudes) as correlates of elderly women’s intention to have a Pap smear.

Methods

This study was a secondary data analysis using a subset sample of the elderly women (≥65 years) who participated in the Texas Tech 5000 Survey Wave 4, a cross-sectional phone interview study conducted in 2002. Intent to have a Pap test, previous gynecologic history, and beliefs/attitudes related to Pap tests were measured. χ² tests and logistic regression were conducted.

Results

Among the 1,044 women in the analytical sample, 70.2% (733) reported intending to have a Pap smear test within the next 2 years. About 77% (449/582) of the women who had not undergone a hysterectomy reported the intend to have a Pap smear, whereas 62% (284/462) of the women who had undergone a hysterectomy reported the same intent (χ ² = 30.26; df = 1; p = .000). Among women who had undergone a hysterectomy, having received a Pap smear within the past 2 years (odds ratio [OR], 21.32; 95% confidence interval [CI], 11.52–39.47), perceiving that their doctors might feel having the test is a good idea (OR, 7.14; 95% CI, 3.15–16.19), and insurance covering the test (OR, 2.21; 95% CI, 1.18–4.15) were positive correlates of intent to have a Pap test. Among women who had not undergone a hysterectomy, previous Pap smear history (OR, 19.28; 95% CI, 10.15–37.10), perceived doctor’s opinion (OR, 5.39; 95% CI, 2.38–12.19), perceived pain of the test (OR, 0.52; 95% CI, .28–.99), perceived importance (OR, 4.00; 95% CI, 1.32–12.10), and perceived risk of developing cervical cancer (OR, 4.27; 95% CI, 1.27–14.33) were correlates.

Conclusions

Public health educational messages intended to increase appropriate use of Pap screening should include factual information about risk factors such as age and possession of an intact cervix. Other messages intended to reduce inappropriate use of Pap screening should be directed at physicians, since many elderly women intend to inappropriately seek Pap tests based on erroneous beliefs/attitudes.